-- Warm up exercises such as a short period of walking and stretching. -- Stretch again after exercising. -- Be sure to wear footwear that is specific to the sport. This may include being evaluated by someone who is knowledgeable in shoe wear and biomechanics, such as an orthopaedic surgeon, pedorthist, or physical therapist. -- Appropriate training for the specific sport. Impact sports such as running will place greater stress on your feet. Without proper training that builds up your tolerance to impact activities, stress fractures can occur.Cross-training with "feet-friendly" non-impact activities, such as swimming, biking, elliptical trainers, and steppers. If maintaining your fitness goals remains difficult, adding an orthotic device in your shoes may offer you what you need to remain active. Before doing this, always have your feet checked by an orthopaedic foot and ankle surgeon. AOFAS member, Stephen J. Pinney, MD, of San Francisco, CA, says, "Walking puts more stress on your feet than you might think! Every time you take a step 2-3 times your body weight goes through your feet, more if you are running. It is not uncommon for an active person to take 10,000-15,000 steps per day. That is a lot of cumulative force going through the sole of the foot and the various tendons that control the movement of the foot. This repetitive loading can predispose to many common 'chronic' foot conditions such as metatarsalgia, tendinitis, and plantar fasciitis. "Metatarsalgia is a painful condition involving the forefoot. It occurs when the tissue in the sole of the forefoot gets irritated and painful from the repetitive loading especially if the force is concentrated in a localized area in the forefoot. It is treated by trying to disperse the force away from the painful area by using appropriate shoe wear and orthotic inserts." He continues, "Tendinitis occurs when a tendon gets excessively overloaded just like a rope that starts to fray after it is subject to wear and tear. The body responds to this type of tendon injury by sending inflammatory mediators to the area and this is what leads to the pain and swelling associated with tendinitis. Depending on which tendons in the foot are excessively loaded will determine which part of the foot will develop tendinitis. Not all of the tendons in the foot are loaded equally in every foot. For example, people with flat feet will tend to excessively load the tendons on the inside of the ankle and may develop symptoms in this area whereas people with higher arched feet are more likely to develop tendinitis symptoms in the outside part of their ankle. Treatment of tendinitis may include: modifying activities to rest the painful area; using shoes and orthotics that help to smoothly spread the force of running or walking up the leg; gently strengthening and stretching the involved tendons; and possibly bracing the ankle." Plantar fasciitis is the most common cause of chronic heel pain. It develops as a result of repetitive microtrauma to the heel region. As Dr. Pinney says, "The plantar fascia is a dense tissue that is found in the sole of the foot beginning at the heel bone. With each step a person takes this tissue is loaded. If someone increases the amount of walking they do, walks on hard surfaces, or gains extra weight they may suffer repetitive microtearing of the plantar fascia insertion. This will lead to heel pain, particularly first thing in the morning, which is a characteristic sign of plantar fasciitis." Like other types of chronic foot pain plantar fasciitis can usually be successfully treated by decreasing the overall loading to the foot. Dr. Pinney recommends, "Wearing appropriate shoes, walking or standing less and on softer surfaces, stretching your calf muscles, or losing extra body weight will all be helpful in decreasing or eliminating the symptoms associated with chronic foot conditions, such as plantar fasciitis." To keep those feet healthy, always remember:
-- Proper shoe wear that is appropriate to the specific sport -- Proper evaluation by an orthopaedic foot and ankle surgeon -- Adequate training -- Stretch before and after exercising -- Mix activities through cross trainingTo find an AOFAS orthopaedic surgeon in your area, go to www.aofas.org. About AOFAS The AOFAS promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. It creates public awareness for the prevention and treatment of foot and ankle disorders, provides leadership, and serves as a resource for government, industry and the national and international health care community. About Orthopaedic Foot and Ankle Surgeons Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who specialize in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle. This includes the bones, joints, ligaments, muscles tendons, nerves, and skin. Orthopaedic foot and ankle surgeons use medical, physical, and rehabilitative methods as well as surgery to treat patients of all ages. They perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle. Orthopaedic foot and ankle surgeons work with physicians of many other specialties, including internal medicine, pediatrics, vascular surgery, endocrinology, radiology, anesthesiology, and others. Medical school curriculum and post-graduate training provides the solid clinical background necessary to recognize medical problems, admit patients to a hospital when necessary, and contribute significantly to the coordination of care appropriate for each patient. Education AOFAS members have the following credentials:
-- Completed four years of medical school. The curriculum covers basic and clinical sciences, surgery, internal medicine, pediatrics, family medicine and all other medical specialties -- Completed five years of accredited graduate medical education (residency training) in orthopaedic surgery -- Many orthopaedic foot and ankle surgeons also complete advanced fellowship training in foot and ankle surgery. -- Satisfactory completion of the national medical licensing examination -- Continuing medical education credits over a specific time period. -- Board certification: Certified by or eligible for examination and certification by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery -- Each member must hold membership in the American Academy of Orthopaedic Surgeons (AAOS).When selecting a medical provider to care for your feet and ankles, be sure to ask him/her about:
-- Medical school education -- Accredited residency training -- Areas of practice specialization -- Experience in your prescribed treatment (surgical and/or non-surgical)
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